The persistent and widespread problem of methamphetamine misuse is shaped not only by the biology of addiction, but by historical and cultural contexts. Methamphetamine is a methylated derivative of amphetamine, which was first synthesized in 1887, by a German chemist. It was first synthesized from ephedrine in 1893, by a Japanese chemist. In 1919, methamphetamine was synthesized in Japan via reduction of ephedrine using red phosphorous and iodine. The first medical use for methamphetamine was marketed by Smith-Kline-French in 1928 as Benzedrine, used in inhalers sold over-the-counter for treating asthma. (Benzedrine led to the street name of “bennies.”). Amphetamines were subsequently found to be effective in treating narcolepsy, nasal congestion, weight gain, and attention deficit disorder, and for providing extended periods of wakefulness (Bender & Cottington, 1942). In the 1930s and 1940s, amphetamines were prescribed for schizophrenia, morphine addiction, and low blood pressure. During World War II, the armies of Japan, Germany, and the United States all provided amphetamines to military personnel to fight fatigue and enhance performance. Amphetamines also were used in Japan to improve the productivity of civilian factory workers in the war industries.

Problems with the misuse of amphetamines quickly emerged in diverse cultural contexts. Although cultural contexts shaped amphetamine use, certain common patterns also are discernible. When problems with addiction became apparent, governments typically attempted to regulate the use of amphetamines, primarily through criminal penalties. Without concurrent efforts in treatment and prevention, strong consumer demand for amphetamines remained. Criminal enterprises quickly moved in to exploit this demand, resulting in additional problems for communities.

The Japanese Case

The case of methamphetamine misuse in Japan is important because it was recognized early as a social problem, hence the various governmental interventions undertaken (as well as changes in distribution) may be considered over time. Examination of the more extended trajectory of methamphetamine misuse in Japan, a modern and technologically advanced society, reveals some similarities and differences to the U.S. case, possibly relevant to U.S. policy. The history and epidemiology of methamphetamine misuse in Japan reflects a complex interaction of widespread addiction due to lack of knowledge about the health risks, followed by partially successful attempts by the government to control resultant problems through criminalization of stimulant misuse, and the subsequent exploitation of persisting demand for stimulants by criminal syndicates.

In 1941, there were no restrictions on the sale of methamphetamine, which was initially sold under the trade name Philopon in Japan. It was sold over the counter to fight sleepiness and enhance vitality. Widespread misuse of methamphetamine occurred after World War II, as methamphetamine from surplus army stocks flooded the market. From 1946 to 1956, Japan experienced a serious stimulant epidemic. In 1950, an ordinance from the Ministry of Health banned all stimulant production. Nonetheless, many pharmaceutical companies illegally produced stimulants and made them available on the black market. In addition, clandestine laboratories produced their own versions of Philopon.

In 1951, enactment of the Stimulants Control Law criminalized stimulant misuse, punishable by up to 3 years imprisonment. By 1954, there were approximately 550,000 chronic stimulant users in Japan, about 10% of whom experienced methamphetamine-induced psychosis. The Stimulant Control Act was amended in 1954 and rigorously enforced to permit harsher penalties for stimulant offences, with terms of up to 5 years imprisonment for the first offense and 7 years for recidivists and traffickers. The Mental Hygiene Law was amended to place drug-addicted persons with symptoms of psychosis in treatment programs in mental health care facilities.

The relatively harsh penalties for stimulant misuse have been credited with largely eliminating the first epidemic of methamphetamine misuse in Japan. From 1954 to 1958, the number of people arrested for violating the Stimulant Control Law decreased to 271- From 1957 to 1969, stimulant misuse was relatively stable in Japan, with approximately 500 persons arrested annually for stimulant use — related offenses.

Since 1970, Japan has experienced a period of economic growth and prosperity. It also has experienced a second stimulant epidemic, as methamphetamine misuse has spread, for example, to students, office workers, and blue-collar workers such as truck drivers. Japan has a strong work ethic and a competitive system of education. For some, methamphetamine may be attractive because it enhances energy and wakefulness, and hence the ability to work and study for long hours.

From 1970 to 1974, the number of people arrested for stimulant use-related offenses doubled each year. In 1973, a harsher criminal penalty was introduced through amendment of the Stimulant Control Law. This legislation was credited with a significant reduction in the problem, but the effect only lasted for 1 year. Over 10,000 people were arrested in 1975 for stimulant use — related offenses. Since 1981, arrest figures have remained at over 20,000 per year.

Methamphetamine misuse has become highly stigmatized and associated with the Japanese underworld. Japanese organized criminal syndicates called bouryokudan or yakuza have come to dominate stimulant supply, a development not characteristic of the first epidemic. In the early 1970s, many gang members and their leaders who had been imprisoned in the 1960s were released, and criminal syndicates expanded their operations throughout Japan. Today, relatively few arrests occur in Japan for production. Rather, stimulants are imported illegally from other Asian countries through organized Japanese gangs, thus introducing other social problems (Anglin et al., 2000; Tamura, 1989).

The South African Case

The South African case demonstrates interactions among the biology of addiction, market economics, and cultural context similar to the Japanese case. Crystal methamphetamine, commonly called tik, is impacting black South-African youths in the impoverished Cape Flats area. South African organized criminal syndicates have a demand for the pseudoephedrine precursor of methamphetamine, as well as illegally manufactured methaqualone (sedative Quaaludes). The Chinese gangs have, in turn, a huge demand for a South-African seafood delicacy, abalone, an endangered and protected species that can eventually be sold to Chinese buyers in Hong Kong for over $200 per pound. In a cash-free black-market transaction, the Chinese Triad gangs and Western Cape drug lords trade abalone for the ingredients to make methamphetamine. Hundreds of tons of abalone are smuggled out of the Cape every year, bringing wild abalone to the brink of extinction in little more than a decade. The South-African drug lords who gained control of significant volumes of abalone also captured a monopoly over cheap crystal meth and illegal Quaaludes. The result is that every serious player in the drug industry must obtain abalone to stay in business. The widespread use of tik among South-African youth has caused an increase in crime and social breakdown, thereby putting enormous stress on already limited social services throughout the Cape. The high-risk sexual behavior associated with tik may cause the HIV epidemic in southern Africa to return.

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